Clinical Factors Affecting Outcomes of Osteochondral Allograft Transplantation: A Multivariable Analysis of 560 Knees.

Background: Osteochondral allograft (OCA) transplantation is a successful treatment option for focal chondral and osteochondral lesions; however, outcomes vary by patient and intraoperative variables. Previous studies have compared outcomes of OCA transplantation using basic descriptive and surgical data; nonetheless, they do not account for possible confounding variables.

Hypothesis/purpose: The purpose of this study was to report overall survivorship of OCA transplantation using a large, long-term registry from a specialty cartilage practice and utilize a multivariable model to identify factors that best predict treatment failure.

Osteochondral Allograft Transplantation.

Osteochondral allograft transplantation in the knee is an effective procedure to treat isolated and complex pathologies of articular cartilage. Osteochondral allograft transplantation has an overall high graft survivorship, ranging between 78% to 91% at 10 years. Patients report significant improvements in pain and function and high satisfaction.

Bracing in Osteoarthritis.

Bracing options for the therapeutic and preventative treatment of cartilage injury and osteoarthrosis have traditionally been understudied and underutilized due to poor patient compliance and a lack of published clinical efficacy data. However, recent advancements in 3-dimensional printing, biomechanical analysis of the joint, and dynamic joint unloading technologies are re-establishing bracing as an effective, low-cost, and low-risk non-surgical treatment option. When combined with other operative and non-operative methods in a data-based approach, bracing may offer improved outcomes in therapeutic, palliative, and prophylactic applications for cartilage disease and injury.

Osteochondral Allograft Transplantation for Large Osteochondral Lesions of the Femoral Head in Young Patients.

Introduction: Osteochondral lesions of the femoral head in young patients are a rare but challenging clinical problem. Fresh osteochondral allograft (OCA) transplantation has been proposed as one potential treatment option that may improve function and delay hip arthroplasty. However, there is a paucity of published data.

Effectiveness of a Supervised Patient Ambulation Program in Reducing Fall Risk Following Total Joint Arthroplasty.

Background: Total hip arthroplasty and total knee arthroplasty rank among the most prevalent orthopaedic procedures performed globally. Early mobilization postarthroplasty reduces complications, shortens length of stay, and optimizes recovery. However, the incidence of falls remains high, leading to complications and increased costs.

Preoperative Resilience as a Predictor of Postoperative Regret and Patient-Reported Outcomes in Total Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) is a well-established treatment option for advanced knee osteoarthritis, yet some patients remain unsatisfied after surgery. Evaluation of various psychosocial parameters may improve patient optimization and outcomes. The primary aim was to assess whether preoperative resilience remained stable and influenced decision regret postoperatively while the secondary aim was to evaluate its correlation with joint-specific and global health patient-reported outcome measures.

Midterm Survivorship and Clinical Outcomes in Fresh Osteochondral Allograft Transplantation for the Treatment of Large Bipolar Lesions of the Knee.

Background: Fresh osteochondral allograft (OCA) transplantation is an established treatment option for patients with chondral or osteochondral lesions of the knee. Predictably positive outcomes are seen in situations of focal or isolated cartilage defects. However, OCA transplantation may also be performed in more complex joint salvage situations in young patients.

What Is the Prevalence of Hip Abductor Pathology in Patients Undergoing Total Hip Arthroplasty?

Background: Total hip arthroplasty (THA) is generally considered a successful operation for patients with advanced hip arthritis. Hip abductor pathology can lead to diminished outcomes. The prevalence of hip abductor pathology in patients undergoing THA is not well described.

Outcomes After Osteochondral Allograft Transplantation of the Medial Femoral Condyle in Patients With Varus and Nonvarus Alignment.

Background: Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized.

Treatment of osteochondral injuries of the humeral head using fresh osteochondral allograft transplantation.

Background: Large osteochondral lesions of the humeral head can result from locked posterior dislocations, avascular necrosis, and osteochondritis dissecans. Fresh osteochondral allograft (OCA) transplantation is a treatment option for young patients with focal osteochondral defects of the humeral head. The purpose of this case series was to assess graft survivorship, subjective patient-reported outcomes, and satisfaction among 7 patients who underwent OCA transplantation of the humeral head.

Elevated Lipid Metabolites in Stored Clinical OCA Media Correlate With Chondrocyte Death.

Background: A major limitation of osteochondral allografts (OCA) is the deterioration of cartilage health associated with cell death during prolonged storage. However, little is known about the mechanisms that contribute to chondrocyte death during storage.

Purpose/hypothesis: This study aimed to determine whether bioactive lipid metabolites accumulate in the storage media of OCA and whether they are associated with a loss of chondrocyte viability during prolonged storage.

Participation in Sports or Recreational Activities After Osteochondral Allograft Transplantation of the Talus.

Background: Fresh osteochondral allograft (OCA) transplantation is a viable treatment option for osteochondral defects of the talus. However, sufficient data are not available on patients' participation in sports or recreational activities after the procedure.

Purpose: To assess whether patients undergoing OCA transplantation of the talus participated in sports or recreational activities postoperatively.

'On Table' Versus 'Off Table' Direct Anterior Approach Total Hip Arthroplasty: Is There a Difference?

Background: The purpose of this study was to evaluate whether there were differences in patient-reported outcomes, operative times, satisfaction scores, and complications between patients undergoing total hip arthroplasty (THA) performed through a direct anterior approach on a specialized traction table or a regular operating room table.

Methods: Patients who underwent a direct anterior approach THA on a specialized table or a regular table with a minimum 1-year follow-up were included. Patient-reported outcome measures and THA satisfaction were recorded.

Subchondral Bone Alignment in Osteochondral Allograft Transplants for Large Oval Defects of the Medial Femoral Condyle: Comparison of Lateral versus Medial Femoral Condyle Donors.

Objective: Supply-demand mismatch of medial femoral condyle (MFC) osteochondral allografts (OCAs) remains a rate-limiting factor in the treatment of osteochondral defects of the femoral condyle. Surface contour mapping was used to determine whether a contralateral lateral femoral condyle (LFC) versus ipsilateral MFC OCA differs in the alignment of donor:native subchondral bone for large osteochondral defects of the MFC.

Design: Thirty fresh-frozen human femoral condyles were matched by tibial width into 10 groups of 3 condyles (MFC recipient, MFC donor, and LFC donor) each for 3 cartilage surgeons (90 condyles).

Osteochondral Allografts for Large Oval Defects of the Medial Femoral Condyle: A Comparison of Single Lateral Versus Medial Femoral Condyle Oval Grafts Versus 2 Overlapping Circular Grafts.

Background: Studies have demonstrated the acceptability of using a contralateral nonorthotopic lateral femoral condyle (LFC) graft for a circular medial femoral condyle (MFC) osteochondral defect up to 20 to 25 mm in diameter. Larger oblong defects can now be managed using either overlapping circle grafts or a single oblong-shaped osteochondral allograft (OCA).

Purpose: To determine if an oblong contralateral nonorthotopic LFC OCA can attain an acceptable surface contour match compared with an oblong ipsilateral MFC OCA or an overlapping circle technique for large oblong defects of the MFC.

Hip and Knee Arthroplasty Outcomes for Nonagenarian Patients.

Introduction: Studies have previously reported higher complication rates in elective total joint arthroplasty (TJA) for nonagenarians compared with younger cohorts. The purpose of this study was to assess whether nonagenarians were still at increased risk of complications and hospital readmissions by answering three questions: (1) Do nonagenarians have an increased risk of medical complications after TJA compared with octogenarians and septuagenarians? (2) Do nonagenarians have an increased risk of surgical complications after TJA compared with octogenarians and septuagenarians? (3) Do nonagenarians have an increased risk of hospital readmission after TJA compared with octogenarians and septuagenarians?

Methods: A total of 174 patients undergoing primary TJA between 2010 and 2017 were included; 58 nonagenarians (older than 90 years) were matched with 58 octogenarians (age 80 to 84 years) and 58 septuagenarians (age 70 to 74). Groups were matched by sex, diagnosis, surgeon, surgical joint, and year of surgery.

Are immediate postoperative X-Rays valuable in evaluating complications of primary total hip arthroplasty?

Purpose: This study aimed to investigate the complications of primary total hip arthroplasty based on immediate postoperative X-rays. The overall quality and cost of X-rays were assessed.

Methods: The institutional database was queried to identify all patients who underwent total hip arthroplasty in a single institution between January 1, 2018, and December 31, 2018.

Inconsistent Reporting of Preauthorization Medical Criteria for Osteochondral Allograft Transplantation Surgery.

Background: Although osteochondral allograft (OCA) transplantation has been a standard treatment for patients with osteochondral lesions, there is a disagreement in commercial payers' medical criteria regarding the definition of medical suitability and thus authorization for OCA transplantation. The primary goal of this study was to understand where consensus between a committee of experienced cartilage restoration surgeon scientists and payer policies existed and where there was significant disagreement.

Methods: U.

No Difference in Blood Loss and Risk of Transfusion Between Patients Treated with One or Two Doses of Intravenous Tranexamic Acid After Simultaneous Bilateral TKA.

Background: Tranexamic acid (TXA) is often used to prevent excessive blood loss during bilateral TKA. Although it diminishes blood loss, TXA may have a potentially elevated thrombogenic risk with extra, unnecessary doses of TXA in this high-risk population. To date, the most efficacious dosing protocol in this setting has not yet been ascertained.

Direct Anterior Approach to Total Hip Arthroplasty Improves the Likelihood of Return to Previous Recreational Activities Compared with Posterior Approach.

Total hip arthroplasty offers relief and functional improvement, with the rate of direct anterior approach (DAA) increasing compared with the posterior approach (PA). This study aimed to assess the effect of surgical approach on return to recreational activity after total hip arthroplasty. Total hip arthroplasty performed for primary or posttraumatic osteoarthritis were identified; 100 DAA patients were matched with 100 PA patients on age, sex, diagnosis, and surgical year.

A Systematic Review of Focal Cartilage Defect Treatments in Middle-Aged Versus Younger Patients.

Background: Focal cartilage defects are often debilitating, possess limited potential for regeneration, are associated with increased risk of osteoarthritis, and are predictive for total knee arthroplasty. Cartilage repair studies typically focus on the outcome in younger patients, but a high proportion of treated patients are 40 to 60 years of age (ie, middle-aged). The reality of current clinical practice is that the ideal patient for cartilage repair is not the typical patient.

Fresh Osteochondral and Chondral Allograft Preservation and Storage Media: A Systematic Review of the Literature.

Background: Storage procedures and parameters have a significant influence on the health of fresh osteochondral allograft (OCA) cartilage. To date, there is a lack of agreement on the optimal storage conditions for OCAs.

Purpose: To systematically review the literature on (1) experimental designs and reporting of key variables of ex vivo (laboratory) studies, (2) the effects of various storage solutions and conditions on cartilage health ex vivo, and (3) in vivo animal studies and human clinical studies evaluating the effect of fresh OCA storage on osteochondral repair and outcomes.

Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft.

Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line treatment for large chondral and osteochondral defects, aided by advancements in storage protocols and a growing body of clinical evidence supporting successful clinical outcomes and long-term survivorship. Despite the body of literature supporting OCAs, there still remains controversy and debate in the surgical application of OCA, especially where high-level evidence is lacking.

Purpose: To develop consensus among an expert group with extensive clinical and scientific experience in OCA, addressing controversies in the treatment of chondral and osteochondral defects with OCA transplantation.

Single Use Instruments for Implanting a Contemporary Total Knee Arthroplasty System Are Accurate, Efficient, and Safe.

Background: Single use instruments (SUI) is a potential mechanism to improve efficiency and reduce cost in total knee arthroplasty (TKA). New technology requires patient safety and surgical accuracy. A multi-center study of SUI vs reusable mechanical instrumentation (RUI) for a TKA system compared implant placement accuracy and operating room (OR) efficiency.

Aspirin used for venous thromboembolism prophylaxis in total hip arthroplasty decreases heterotopic ossification.

Background: Heterotopic ossification (HO) is a known complication of total hip arthroplasty (THA) that can lead to persistent pain, stiffness, nerve impingement, and instability. Aspirin (ASA) has become an increasingly popular method of venous thromboembolism (VTE) prophylaxis, given its availability, ease of use, and relative safety. Although indomethacin has been commonly used for HO prophylaxis, we wanted to determine whether ASA, given the similar mechanism of action, may be effective in reducing the risk of HO in routine unilateral, primary THA when already being used for VTE prophylaxis.